Amniocentesis

What is the risk of miscarriage from amniocentesis?

The risk of miscarriage due to amniocentesis is low. Because a certain percentage of women will end up miscarrying in the second trimester anyway, there's no way of knowing for sure whether a miscarriage following an amnio was actually caused by the procedure.

Estimates vary, but according to the American College of Obstetricians and Gynecologists (ACOG), the loss rate from the procedure is as low as 1 in 300 to 500 — and perhaps even lower if the doctor or center has a lot of experience performing amnios.

Is there any way to reduce the risk?

Ask your practitioner or genetic counselor to refer you to a doctor with plenty of experience or a center that performs a lot of amnios. And ask about the estimated procedure-related miscarriage rate of the doctor or the center where you're considering having the procedure done.

You'll also want to make sure that an experienced registered diagnostic medical sonographer provides continuous ultrasound guidance during the procedure. This greatly improves the chances that the doctor will be able to obtain enough fluid on the first try, so you can avoid having to repeat the procedure. And when continuous ultrasound guidance is used, injuries to the baby from the amnio needle are very rare.

Can I meet with a genetic counselor before deciding whether to have an amnio?

Yes. In fact, most testing centers require that you meet with a genetic counselor to discuss the risks and benefits of various methods of prenatal screening and testing before you have an invasive procedure like amniocentesis or CVS. The counselor will take down your family history and ask questions about your pregnancy.

Your answers will enable the counselor to give you a sense of your risk for having a baby with chromosomal problems or a particular genetic disease. Then you can decide whether you want to be screened, go right for CVS or amnio, or skip the testing altogether.

How can I decide what's right for me?

ACOG recommends that women of all ages be offered first- and second-trimester screening and diagnostic testing options. Your practitioner or genetic counselor should discuss the pros and cons of the available approaches with you. But ultimately, whether or not to test is a personal decision.

Many women opt for screening and then make a decision about diagnostic testing based on the initial results. Other women opt for diagnostic testing right away. (They may know that they're at high risk for a chromosomal problem or a condition that can't be detected by screening — or they may feel that they want to know as much as possible about their baby's condition and are willing to live with the small risk of miscarriage to find out.) Some women decide to have no screening or testing.

If you opt for screening first, you can then decide — with the help of your practitioner or genetic counselor — whether your results indicate a high enough risk that you want to have CVS or amnio to determine whether a problem exists. You'll need to weigh your need to know about your baby's condition against the small chance that diagnostic testing could cause a miscarriage.

Some women who opt for invasive testing are pretty clear in advance that they would terminate the pregnancy if a serious problem were found. Others may decide to have an amnio even though they aren't sure what they'd do if they got bad news.

Some women may decide to have an amnio even if they know they would never terminate a pregnancy. They may feel that finding out that their baby will have special needs will help them prepare emotionally for the challenges ahead. In certain cases, they may want to switch to a better-equipped hospital with specialists.

There are a few conditions that may be treated while the baby is still in the womb. So if there's a strong suspicion that your baby may have one of these rare problems, you might opt for an amnio to find out.

On the other hand, some women feel strongly about not having a procedure that increases their risk of miscarriage, especially if the results aren't going to affect the management of their pregnancy. So they decide not to have invasive testing.

There's no one right decision. Individual parents-to-be have different feelings about what risks are acceptable and may arrive at different conclusions when facing the same set of circumstances.

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